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Essential Guidelines for Medication Administration

Sep 11, 2024

Medication Administration: Six Rights

To prevent medication errors, healthcare professionals must adhere to the six rights of medication administration. Each time a drug is prepared for administration, consider the following:

1. Right Medication

  • Verify Medication: Check the Medication Administration Record (MAR) for clarity and completeness. An order must include:
    • Patient's full name
    • Drug ordered
    • Dosage
    • Route of administration
    • Time of administration
  • Check Against MAR:
    • For prepackaged unit dose medications, verify the label with the MAR at three points:
      • When removing medication from the dispensing system
      • When placing it in the medicine cup
      • At the patient's bedside
  • Label Prepared Medications: If the medication is not in its original container, label it with drug name, strength, amount, and expiration date/time.
  • Dose Calculation:
    • Convert measurements if necessary and verify calculations with another nurse.
    • Follow guidelines for high-alert medications (insulin, narcotics, sedatives, anticoagulants).

2. Right Dose

  • Liquid Medications: Use standard measuring devices (syringe or graduated cup).
  • Tablet Splitting/Crushing:
    • Use pharmacy services or a cutting device for splitting scored tablets.
    • Mix crushed tablets with food or liquid.
    • Never crush sublingual, enteric-coated, or extended-release tablets.

3. Right Patient

  • Identification: Use two identifiers:
    • Confirm with ID band
    • Ask patient to state full name and birthdate
    • Avoid using room numbers

4. Right Route

  • Verify Route:
    • Ensure the route is specified in the order
    • Consult prescriber if route is missing or not recommended
  • Injection Safety:
    • Use only preparations intended for parenteral use
    • Oral medications are not for injection

5. Right Time

  • Timing Guidelines:
    • Follow agency schedule for routine meds
    • Non-time-critical meds: within 1-2 hours
    • Time-critical meds: STAT doses immediately, "now" doses within 60 mins
    • Use clinical judgment for other doses (e.g., with food)

6. Right Documentation

  • Record Keeping:
    • Document patient pre-assessments and responses to PRN meds promptly
    • Follow-up care documentation includes teaching patients about medications

Additional Notes

  • Education: Teach patients about medication use and remain vigilant against errors.
  • Nurse Responsibilities: Understand rights and duties; refer to resources like instructional videos on preventing medication errors.

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